Pharmacist, Heal Thyself

Katherine Eban's moving article ["Your Hospital's Deadly Secret," March] about the hospital-pharmacy error that caused the tragic death of Baby Alyssa shines a needed light on the lethal toll that deficits in pharmacy management and leadership can take. Baby Alyssa's death is all the more tragic because this mistake could and should have been prevented at any step in the process. Hospital pharmacies must be zones in which patient safety is the top concern. This mind-set can be achieved in pharmacies managed by contract companies as well as in any hospital-managed pharmacy. Professional standards, best practices, and guidelines—many published by the American Society of Health-System Pharmacists—are readily available and must be followed by all practitioners.

As with any medical error, numerous factors contributed to this tragedy. Each of these contributing errors can be traced to a lack of consistent and effective pharmacy leadership, the absence of effective checks and balances throughout the medication-use process, failure to take full advantage of the safety features available in automated technology, and poor staff training, especially of pharmacy technicians.

Most Americans are unaware that there are no standard requirements for how pharmacy technicians are trained, educated, regulated, or licensed. In some states, there are no requirements at all. In Nevada, where Summerlin Hospital is located, the Nevada Board of Pharmacy recently took a first step toward these goals by adopting regulations that require pharmacy-technician-training programs offered by postsecondary schools to be accredited by A.S.H.P.  Preparing pharmacy technicians appropriately for the high-wire act of safely handling medications is just one of the things that must occur if we are going to prevent errors like this from taking any more lives.

—Henri R. Manasse Jr., American Society of Health-System Pharmacists, Bethesda, Maryland

Eban's article reaffirms my observations of the evolution of the health-care industry through my 20-year tenure in it. The ugly truth is that some health-care professionals have become comfortable blaming high patient count and inadequate staffing for chronically poor performance.

As with most businesses, the challenge is to adapt to producing at the same level—or higher—with fewer resources while continuing to provide good service. The real issue in this case is not that a tragic incident took place when a health-care system reduced its expenses by using a contract-management company. The issue is the dangerous and chronically apathetic attitude toward patient welfare.

As a registered nurse, I am drawn to a few lines in the article. To mix saline bags with saline-and-potassium bags, an example cited in the article, certainly invites a calamity. At the same time, patient safety is everyone's responsibility. Couldn't a single nurse have taken ownership of separating mixed-medication bags as he or she fished through the storage bin day after day, shift after shift? No policy to be written, no committee to be formed, no overtime to be taken, and no rocket scientist to be consulted.

—Debbie F. Wegryn, Amherst, Ohio

Iraqi Oil Slick

Thanks and congratulations on the March issue, your best yet. It was neither too business-centered for people like me nor too froufrou for the titans of industry. Denis Johnson's story, "Boomtown, Iraq," on oil reserves in Kurdistan, was a classic. Keep it up.

—Michael Lottman, Kingston Springs, Tennessee

Assyrians, Turkomans, and Yezidis find themselves fighting for political and cultural survival in the Kurdish region of Iraq. The Kurdistan Regional Government representatives insist they are democratizing, yet we see that quite the opposite is happening. Two powerful Kurdish families are sustaining political and economic structures that ensure their authority in the region, moving the Kurds—and Iraq—further from democracy. Iraq's northern oil fields are booming, the K.R.G. is secular in nature, and the Kurds are pro-America. This state of affairs is much like that of Iraq in the early 1980s. How long will Iraqis trade one tyranny for another in the name of good business?

—Waleeta Canon, Washington, D.C.

Denis Johnson introduced George Yacu, a technical adviser to Iraq's national oil company for nearly 30 years, as a Chaldean Christian Kurd. Yacu is an Assyrian who is a member of the Chaldean church, not a Kurd. The Chaldean church is one of many denominations that belong to the Assyrian Church of the East, whose members are ethnically Assyrian. Assyrians adopted Christianity in the first century and are indigenous to today's Iraq. The Kurds are newcomers to the region.

—Andrew Bet-Shlimon, Lincoln, Rhode Island

Pirates Ahoy!

Daniel Roth's exceptional exposé on the digital pranksters ["The Pirates Can't Be Stopped," February] read like a true account of disgraced New Republic writer Stephen Glass' made-up story about Jukt Micronics. Fantastic job. But there's one thing that could have improved the article: changing Roth's reference to a website's receiving 23,000 hits. Any decent site can garner that many hits. Next time, please cite unique pageviews or visitors.

—Mike Kuhlmann, Elk Grove, California

Dow Jones Diva

The choice of Natalie Bancroft ["Lady Sings the News," March] to join the News Corp. board was a wise one. At 27, she is years younger than the other board members. When Rupert Murdoch picked Bancroft, he must have known that she is well equipped to understand the new generation of readers and viewers that will be necessary for the company to succeed. Murdoch is again thinking ahead.

—Buddy Nevins, Plantation, Florida

Donors' Dilemma

I was fascinated by Genevieve Smith's article ["What's in a Business School's Name," March] about the University of Wisconsin School of Business' decision to pass up naming opportunities and the financial benefits it has realized in doing so. I wholeheartedly agree with the dean's assessment that locking into naming-rights deals, particularly in perpetuity, is not a good idea for universities. It's also not a good idea for donors. By focusing narrowly on naming rights, donors are distracted from more-important matters. If all a donor wants is his or her name plastered across a building, so be it. There are plenty of for sale signs out there. Until other colleges realize that they can increase donations by focusing on substance rather than feeding egos, donors need to understand that a buyer beware sticker should be affixed to any and every naming "opportunity" presented to them. What they may get may not be what they want.

—Frederic J. Fransen, Center for Excellence in Higher Education, Fishers, Indiana

Rent or Buy?

John Cassidy's analysis ["The Bankers' Bailout," March] of governmental involvement in the subprime-mortgage crisis was accurate. However, he missed one critical aspect. Over the years, we have continually heard our leaders speak of making housing "affordable for all Americans," words that bear no political-party affiliation but that do have regulatory and economic consequences. Bank regulators have knowingly and deliberately compromised the quality of mortgage loans in order to satisfy the political call for homeownership. This has resulted in a homeownership bubble during the past several years.

While homeownership is generally viewed as positive, it is not the best idea for all individuals, and renting is proper under certain circumstances. Individual consumers have been pulled into subprime mortgages because of the tax advantages involved, the ease of obtaining loans for real estate, low (and adjustable) interest rates, mortgage brokers' ability—for a significant fee—to increase credit scores by giving credit cards to high-risk borrowers, and the acceptability by bank regulators of negative equity positions for borrowers. These factors, and others, were encouraged by the banking industry and bank regulators alike. The industry never stopped to consider the consequences and responsibilities involved in homeownership. We made it too easy for people to own a home.

One of our political leaders has recognized this problem. Senator Barack Obama wrote in the August 29, 2007, issue of the Financial Times that the housing bubble was a result of excessive lobbying and influence to "defeat commonsense rules of the road."

He noted that while making homeownership easier started as a good idea, it resulted in lenders pushing "low-income buyers into homes they could not possibly afford." I believe that Senator Obama has the correct insight into the subprime crisis. However, as with all political figures, he shows a weakness by leaving the solution of this problem to the federal government—the institution that allowed it to happen in the first place.

—Martin Gorski, Darien, Illinois

The Conversation …

What has the Black-Scholes model wrought?

No one sat on the fence regarding Michael Lewis' "Inside Wall Street's Black Hole," about the Black-Scholes model, a formula commonly used to measure risk in the financial industry. Lewis wrote, "The striking thing about the seemingly endless collapse of the subprime-mortgage market is how egalitarian it has been. It's nearly impossible to draw a demographic line between the victims and the perps," the point being that homeowners and Wall Street banks made similar bets on real estate prices and are both suffering in their own very different ways.

Many people disagreed with Lewis. "Egalitarian!" a reader with the screen name Rabbit wrote in disgust. "Stan O'Neal took tens of millions of dollars off the table and the 'ordinary' folks are losing their homes."

Others pointed out that ignorance of the risks didn't cause the subprime mess. "Everyone in the chain knew the business was corrupt," SRK wrote. "Borrowers were getting cash knowing that, in the worst case, they could walk away from their homes. And investment bankers were making huge bonuses on placing mortgage-backed securities."

Many readers took exception to the fact that Lewis decided to look at Black-Scholes in the first place. "I can tell you firsthand that everyone on Wall Street understands the flaws in Black-Scholes," an anonymous reader wrote. "Many more-sophisticated models exist and are in use. The deeper problem is not only that markets are unpredictable, but the distribution of risks is also unknowable."

Nowadays, "Black-Scholes is used basically as a convention, not an analytic tool," Bondguy wrote, pointing out that the models banks use to make trading decisions or to determine what's under- or overvalued are generally much more complex than Black-Scholes. "I doubt that those sophisticated models incorporate naive assumptions, like symmetrical return distributions or infinite liquidity, that allow anyone to short a market as much as they want or need to at any time. Yes, much went wrong in this crisis, and faulty models probably deserve much of the blame. But not Black-Scholes."

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